NO PERMIT NUMBER LOT NO.
NO. sTk .T
APPLICATION FOR PLUMBING PERMIT
z d CITY OF CUPERTINO
x o Sanitary No.
11
a Date ® - 16 Permit No
.0 NOV G 1967 �) Fee $
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes andl/sqq��TTfi to list on the reverse side hereof, and agrees to install said prices
> and/or frxiltte inUgcort cPiPTt¢�,� 'ovisions of the Plumbing Code of the City of
a w Cupertino, and all other la apprlc361e thereto.
w x
LL Use of Premises
00
3 Owner - Addres g
z fly Address PIERCE PLUMBING
3 u CONTRACTOR, AGENT 11135 AUZERAIS AVE.
w = PhoneSAN JOSE. CALIF. 011—
w w
ao State License -z Approved /
—U 1 ' PLUMBING INSPECTOR /
FIXTURES
UNITS FEES UNITS1 FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sisks To Main Drain
Com Sink s Trays To Curb j
Dental Units
Drinking Fountains
floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
qrea Drains Main Drain Fee
W ate[ Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough-
Rough. Complete..
Main Drain
Final...